Download PDF
Int J Angiol 2023; 32(04): 262-268
DOI: 10.1055/s-0042-1743409
Case Report

COVID-19-Associated Portal Vein Thrombosis Post-Cholecystitis

Sara Guevara   *
1   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
2   Department of Family Medicine, Glen Cove Hospital, Glen Cove, New York
,
Santiago J. Miyara   *
3   Feinstein Institutes for Medical Research, Manhasset, New York, USA
4   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
,
Judith Aronsohn   *
1   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
5   Department of Anesthesiology, North Shore University Hospital, Manhasset, New York
,
Joseph T. Homsi
6   Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Alexia McCann-Molmenti
7   Department of Surgery, North Shore University Hospital, Manhasset, New York
,
James M. Mumford
1   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
2   Department of Family Medicine, Glen Cove Hospital, Glen Cove, New York
,
Barbara Keber
1   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
2   Department of Family Medicine, Glen Cove Hospital, Glen Cove, New York
,
Linda Shore-Lesserson
1   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
5   Department of Anesthesiology, North Shore University Hospital, Manhasset, New York
,
Luis Morales
7   Department of Surgery, North Shore University Hospital, Manhasset, New York
,
Christine N. Metz
1   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
3   Feinstein Institutes for Medical Research, Manhasset, New York, USA
4   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
,
Young Min Cho
8   Department of Internal Medicine, Northeast Georgia Medical Center, Gainesville, Georgia
,
Christine L. Sardo Molmenti
9   Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Great Neck, New York
,
Rodrigo Loto
10   Department of Radiology, Delta Sanatorium, Rosario, Santa Fe, ARG
,
Martin M. Pesce
10   Department of Radiology, Delta Sanatorium, Rosario, Santa Fe, ARG
,
Stefanos Zafeiropoulos
3   Feinstein Institutes for Medical Research, Manhasset, New York, USA
4   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
,
Dimitrios Giannis
3   Feinstein Institutes for Medical Research, Manhasset, New York, USA
,
Derek O. Pipolo
7   Department of Surgery, North Shore University Hospital, Manhasset, New York
,
Francky Jacque
7   Department of Surgery, North Shore University Hospital, Manhasset, New York
,
Lisandro Montorfano
7   Department of Surgery, North Shore University Hospital, Manhasset, New York
,
Koichiro Shinozaki
1   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
11   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
,
Muhammad Shoaib
1   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
3   Feinstein Institutes for Medical Research, Manhasset, New York, USA
,
Rishabh C. Choudhary
3   Feinstein Institutes for Medical Research, Manhasset, New York, USA
11   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
,
Mitsuaki Nishikimi
3   Feinstein Institutes for Medical Research, Manhasset, New York, USA
11   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
,
Ryosuke Takegawa
3   Feinstein Institutes for Medical Research, Manhasset, New York, USA
11   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
,
Yusuke Endo
3   Feinstein Institutes for Medical Research, Manhasset, New York, USA
11   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
,
Kei Hayashida
3   Feinstein Institutes for Medical Research, Manhasset, New York, USA
11   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
,
Fermin M. Fontan
12   Department of Surgery, Memorial Medical Center, Las Cruces, New Mexico
,
Lance B. Becker
1   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
3   Feinstein Institutes for Medical Research, Manhasset, New York, USA
4   Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
11   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
,
Ernesto P. Molmenti
1   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
3   Feinstein Institutes for Medical Research, Manhasset, New York, USA
7   Department of Surgery, North Shore University Hospital, Manhasset, New York
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

This case study describes a 45-year-old Caucasian male with a past medical history of obesity, hypertension, and non-insulin-dependent diabetes mellitus, who in the setting of coronavirus disease 2019 (COVID-19) pneumonia, developed portal vein thrombosis (PVT) presenting as an acute abdomen after hospital discharge from a cholecystitis episode. PVT is a very infrequent thromboembolic condition, classically occurring in patients with systemic conditions such as cirrhosis, malignancy, pancreatitis, diverticulitis, autoimmunity, and thrombophilia. PVT can cause serious complications, such as intestinal infarction, or even death, if not promptly treated. Due to the limited number of reports in the literature describing PVT in the COVID-19 setting, its prevalence, natural history, mechanism, and precise clinical features remain unknown. Therefore, clinical suspicion should be high for PVT, in any COVID-19 patient who presents with abdominal pain or associated signs and symptoms. To the best of our knowledge, this is the first report of COVID-19-associated PVT causing extensive thrombosis in the portal vein and its right branch, occurring in the setting of early-stage cirrhosis after a preceding episode of cholecystitis.

Keywords

COVID-19 - SARS-CoV-2 - portal vein thrombosis - acute abdomen - thromboembolic condition

* Authors had equal contribution.




Publication History

Article published online:
24 May 2022

© 2022. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Sobhonslidsuk A, Reddy KR. Portal vein thrombosis: a concise review. Am J Gastroenterol 2002; 97 (03) 535-541
    CrossrefPubMedGoogle Scholar
  • 2 Handa P, Crowther M, Douketis JD. Portal vein thrombosis: a clinician-oriented and practical review. Clin Appl Thromb Hemost 2014; 20 (05) 498-506
    CrossrefPubMedGoogle Scholar
  • 3 Intagliata NM, Caldwell SH, Tripodi A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology 2019; 156 (06) 1582-1599.e1
    CrossrefPubMedGoogle Scholar
  • 4 Mantaka A, Augoustaki A, Kouroumalis EA, Samonakis DN. Portal vein thrombosis in cirrhosis: diagnosis, natural history, and therapeutic challenges. Ann Gastroenterol 2018; 31 (03) 315-329
    PubMedGoogle Scholar
  • 5 Margini C, Berzigotti A. Portal vein thrombosis: the role of imaging in the clinical setting. Dig Liver Dis 2017; 49 (02) 113-120
    CrossrefPubMedGoogle Scholar
  • 6 Primignani M. Portal vein thrombosis, revisited. Dig Liver Dis 2010; 42 (03) 163-170
    CrossrefPubMedGoogle Scholar
  • 7 Grendell JH, Ockner RK. Mesenteric venous thrombosis. Gastroenterology 1982; 82 (02) 358-372
    CrossrefPubMedGoogle Scholar
  • 8 Tessler FN, Gehring BJ, Gomes AS. et al. Diagnosis of portal vein thrombosis: value of color Doppler imaging. AJR Am J Roentgenol 1991; 157 (02) 293-296
    CrossrefPubMedGoogle Scholar
  • 9 Bach AM, Hann LE, Brown KT. et al. Portal vein evaluation with US: comparison to angiography combined with CT arterial portography. Radiology 1996; 201 (01) 149-154
    CrossrefPubMedGoogle Scholar
  • 10 Danila M, Sporea I, Popescu A, Șirli R. Portal vein thrombosis in liver cirrhosis— the added value of contrast enhanced ultrasonography. Med Ultrason 2016; 18 (02) 218-233
    CrossrefPubMedGoogle Scholar
  • 11 Wichmann D, Sperhake JP, Lütgehetmann M. et al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study. Ann Intern Med 2020; 173 (04) 268-277
    CrossrefPubMedGoogle Scholar
  • 12 Ali MAM, Spinler SA. COVID-19 and thrombosis: from bench to bedside. Trends Cardiovasc Med 2021; 31 (03) 143-160
    CrossrefPubMedGoogle Scholar
  • 13 Xu X, Chang XN, Pan HX. et al. [Pathological changes of the spleen in ten patients with coronavirus disease 2019(COVID-19) by postmortem needle autopsy]. Zhonghua Bing Li Xue Za Zhi 2020; 49 (06) 576-582
    PubMedGoogle Scholar
  • 14 Klok FA, Kruip MJHA, van der Meer NJM. et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis. Thromb Res 2020; 191: 148-150
    CrossrefPubMedGoogle Scholar
  • 15 Gómez-Mesa JE, Galindo-Coral S, Montes MC, Muñoz Martin AJ. Thrombosis and Coagulopathy in COVID-19. Curr Probl Cardiol 2021; 46 (03) 100742
    CrossrefPubMedGoogle Scholar
  • 16 Juthani P, Bhojwani R, Gupta N. Coronavirus disease 2019 (COVID-19) manifestation as acute myocardial infarction in a young, healthy male. Case Rep Infect Dis 2020; 2020: 8864985
    PubMedGoogle Scholar
  • 17 Acharya S, Anwar S, Siddiqui FS, Shabih S, Manchandani U, Dalezman S. Renal artery thrombosis in COVID-19. IDCases 2020; 22: e00968
    CrossrefPubMedGoogle Scholar
  • 18 Oxley TJ, Mocco J, Majidi S. et al. Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med 2020; 382 (20) e60
    CrossrefPubMedGoogle Scholar
  • 19 Ackermann M, Verleden SE, Kuehnel M. et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med 2020; 383 (02) 120-128
    CrossrefPubMedGoogle Scholar
  • 20 Miyara SJ, Becker LB, Guevara S. et al. Pneumatosis intestinalis in the setting of COVID-19: a single center case series from New York. Front Med 2021; 8: 638
    CrossrefPubMedGoogle Scholar
  • 21 Hassan W, Ramadan HK. COVID-19 as a novel etiology of portal vein thrombosis: change in the current management concepts. Infect Dis (Lond) 2021; 53 (02) 148-150
    CrossrefPubMedGoogle Scholar
  • 22 Balfour GW, Stewart TG. Case of enlarged spleen complicated with ascites, both depending upon varicose dilatation and thrombosis of the portal vein. Edinburgh Med J 1869; 14 (07) 589-598
    PubMedGoogle Scholar
  • 23 Wang JT, Zhao HY, Liu YL. Portal vein thrombosis. Hepatobiliary Pancreat Dis Int 2005; 4 (04) 515-518
    PubMedGoogle Scholar
  • 24 Amitrano L, Guardascione MA, Brancaccio V. et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol 2004; 40 (05) 736-741
    CrossrefPubMedGoogle Scholar
  • 25 Sinz S, Glaser-Gallion F, Steffen T. Portal vein thrombosis in COVID-19 infection. Surg Case Rep 2021; 7 (01) 87
    CrossrefPubMedGoogle Scholar
  • 26 Plemmons RM, Dooley DP, Longfield RN. Septic thrombophlebitis of the portal vein (pylephlebitis): diagnosis and management in the modern era. Clin Infect Dis 1995; 21 (05) 1114-1120
    CrossrefPubMedGoogle Scholar
  • 27 Choi SJ, Min JW, Yun JM. et al. [Portal vein thrombosis with sepsis caused by inflammation at colonic stent insertion site]. Korean J Gastroenterol 2015; 65 (05) 316-320
    CrossrefPubMedGoogle Scholar
  • 28 Carnish MD, Garrett MD, Slome MS. A case of septic portal vein thrombosis (pylephlebitis). Med Forum 2015; 15 (01) 21
    CrossrefPubMedGoogle Scholar
  • 29 Bikdeli B, Madhavan MV, Jimenez D. et al; Global COVID-19 Thrombosis Collaborative Group, Endorsed by the ISTH, NATF, ESVM, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol 2020; 75 (23) 2950-2973
    CrossrefPubMedGoogle Scholar
  • 30 Giannis D, Ziogas IA, Gianni P. Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol 2020; 127: 104362
    CrossrefPubMedGoogle Scholar
  • 31 Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (04) 844-847
    CrossrefPubMedGoogle Scholar
  • 32 Lippi G, Favaloro EJ. D-dimer is associated with severity of coronavirus disease 2019: a pooled analysis. Thromb Haemost 2020; 120 (05) 876-878
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Jafari SH, Naseri R, Khalili N, Haseli S, Bahmani M. Portal vein thrombosis associated with COVID-19: points to consider. BJR Case Rep 2020; 6 (03) 20200089
    PubMedGoogle Scholar
  • 34 Meizoso JP, Moore HB, Moore EE. Fibrinolysis shutdown in COVID-19: clinical manifestations, molecular mechanisms, and therapeutic implications. J Am Coll Surg 2021; 232 (06) 995-1003
    CrossrefPubMedGoogle Scholar
  • 35 Sharma N, Shukla R, Kumar K, Arora S, Warrier R, Philip S. Portal vein thrombosis—a rare complication of SARS-CoV-2 infection. SN Compr Clin Med 2021; 1–4: 1-4
    PubMedGoogle Scholar
  • 36 Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020; 18 (05) 1094-1099
    CrossrefPubMedGoogle Scholar
  • 37 Thachil J, Tang N, Gando S. et al. DOACs and “newer” hemophilia therapies in COVID-19: reply. J Thromb Haemost 2020; 18 (07) 1795-1796
    CrossrefPubMedGoogle Scholar
  • 38 Rondina MT, Wheeler M, Rodgers GM, Draper L, Pendleton RC. Weight-based dosing of enoxaparin for VTE prophylaxis in morbidly obese, medically-ill patients. Thromb Res 2010; 125 (03) 220-223
    CrossrefPubMedGoogle Scholar
  • 39 Thachil J. The versatile heparin in COVID-19. J Thromb Haemost 2020; 18 (05) 1020-1022
    CrossrefPubMedGoogle Scholar
  • 40 Turshudzhyan A. Anticoagulation options for coronavirus disease 2019 (COVID-19)-induced coagulopathy. Cureus 2020; 12 (05) e8150
    PubMedGoogle Scholar
  • 41 Muneer M, Abdelrahman H, El-Menyar A, Zarour A, Awad A, Al-Thani H. Acute cholecystitis complicated with portal vein thrombosis: a case report and literature review. Am J Case Rep 2015; 16: 627-630
    CrossrefPubMedGoogle Scholar
  • 42 Ogren M, Bergqvist D, Björck M, Acosta S, Eriksson H, Sternby NH. Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol 2006; 12 (13) 2115-2119
    CrossrefPubMedGoogle Scholar
  • 43 Franco-Moreno A, Piniella-Ruiz E, Montoya-Adarraga J. et al. Portal vein thrombosis in a patient with COVID-19. Thromb Res 2020; 194: 150-152
    CrossrefPubMedGoogle Scholar
  • 44 Giannis D, Allen SL, Tsang J. et al. Postdischarge thromboembolic outcomes and mortality of hospitalized patients with COVID-19: the CORE-19 registry. Blood 2021; 137 (20) 2838-2847
    CrossrefPubMedGoogle Scholar